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Shaakir Hasan



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    OA13 - Therapeutics and Radiation for Small Cell Lung Cancer (ID 927)

    • Event: WCLC 2018
    • Type: Oral Abstract Session
    • Track: Small Cell Lung Cancer/NET
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 10:30 - 12:00, Room 203 BD
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      OA13.07 - Survival Outcomes After Whole Brain Radiotherapy for Brain Metastases in Elderly Patients with Newly Diagnosed Metastatic Small Cell Carcinoma. (ID 13900)

      11:35 - 11:45  |  Author(s): Shaakir Hasan

      • Abstract
      • Presentation
      • Slides

      Background

      Small cell lung cancer (SCLC) is an aggressive malignancy with a tendency to affect the elderly and to metastasize to the brain. However, elderly patients tolerate whole brain radiotherapy (WBRT) poorly with potentially detrimental effects on quality of life. Accordingly, the survival benefit of WBRT in this population is unclear. We utilized the national cancer database (NCDB) to evaluate the survival outcomes following WBRT in elderly patients with SCLC and brain metastases.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We analyzed 1615 patients >75 years old diagnosed with SCLC and brain metastases at diagnosis. Patients were categorized by type of therapy: chemotherapy + WBRT (n=576), chemotherapy alone (n=238), WBRT alone (n=360) and no chemotherapy or WBRT (n=441). Clinical and demographic characteristics were reported for each treatment cohort with a subsequent multivariable regression analysis for survival. Propensity score-matching analysis was used for balance between comparison groups.

      4c3880bb027f159e801041b1021e88e8 Result

      Median patient age was 79 years. 51% had brain-only metastatic disease. Whole brain radiation median dose delivered was 30 Gy (1.8-40 Gy). Median follow up was 2.8 months (0.03-68.01) for all patients. Of the patients included in this study, 1530 had died at time of analysis yielding a median OS of 2.9 months with 6 month and 1 year survivals of 31% and 12%, respectively.

      For patients without chemotherapy, median OS with WBRT was 1.9 months compared to 1.2 months without WBRT (p<0.0001). For patients receiving chemotherapy with, and without WBRT, median OS was 5.6 months and 6.4 months, respectively (p=0.43). Multivariable cox regression revealed age >80, extracranial disease, male sex, and rural location as predictors of increased risk of death.

      figure 1.png

      8eea62084ca7e541d918e823422bd82e Conclusion

      In elderly patients 75 years old or greater with SCLC brain metastasis, WBRT was associated with a modest increase in survival in patients not fit for chemotherapy, and there was no association with increased survival over chemotherapy alone.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P2.16 - Treatment of Early Stage/Localized Disease (Not CME Accredited Session) (ID 965)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/25/2018, 16:45 - 18:00, Exhibit Hall
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      P2.16-20 - Prognostic Utility of PET in Non-Small Cell Lung Cancer After Empiric Stereotactic Body Radiotherapy (SBRT) (ID 11292)

      16:45 - 18:00  |  Presenting Author(s): Shaakir Hasan

      • Abstract
      • Slides

      Background

      Positron emission tomography (PET-CT) is valuable for diagnosing early stage non-small cell lung cancer (NSCLC) in the absence of biopsy. Here we investigate the diagnostic, prognostic, and treatment response of PET-CT in NSCLC treated with empiric stereotactic body radiotherapy (SBRT).

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed 78 empiric lung SBRT cases with pre-treatment PET scans treated to biologic equivalent dose>100 Gy10. We correlated pre and post-treatment standard uptake values (SUV) with local, regional, and distant control. Statistical analysis was conducted via SPSS v20.

      4c3880bb027f159e801041b1021e88e8 Result

      A total of 44 males and 34 females median age 77 were treated to 48 Gy in 4 fractions (n=47) or 50 Gy in 5 fractions (n=31). Lung nodules were 1.6 cm (0.6–4.5 cm) with a median planning target volume of 19.1 cc (3.7-97.4 cc). Median pre-treatment SUV=4.1 (0-20). Of the 43 patients with post-treatment PETs, median SUV = 2.7(0-7.2) or 53%(0-302%) of the pretreatment SUV.

      The median follow-up was 18 months with a 3-year survival of 50% for all patients. Local, regional, and distant control rates at 3 years were 91%, 81%, and 78%, respectively. Relative sisease control for pre-treatment SUV <4.0 compared to >4.0 is shown in Table 1:

      Pre-treatment

      SUV >4 vs < 4

      Hazard Ratio (Confidence Interval)

      P Value

      Local Failure

      5.92 (0.74 – 47.15)

      0.08

      Regional Failure

      6.67 (1.86 – 23.98)

      <0.01

      Distant Failure

      3.28 (1.02 – 10.55)

      0.04

      Overall Progression

      3.62 (1.43 – 9.12)

      <0.01

      There was no difference in tumor size, location, nodule morphology, or prior cancer/smoking history between patients with pre-treatment SUV < 4 (n=40) and > 4 (n=38). Receiver operating characteristic curve analysis identified optimal SUV cutoff values of 6.0, 3.5, and 4.0 to predict local, regional, and distant failure, respectively. Post-SBRT PET scans with SUV reduction >50% demonstrated a 2-year freedom from progression of 89% compared to 57% with SUV reduction <50% (P=0.08).

      8eea62084ca7e541d918e823422bd82e Conclusion

      Our study demonstrates a strong correlation between initial PET avidity and regional/distant recurrence, and a trend with local recurrence. Perhaps patients with pretreatment SUV>4 warrant a mediastinal evaluation or closer vigilance in follow-up, though this warrants prospective investigation.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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    P3.08 - Oligometastatic NSCLC (Not CME Accredited Session) (ID 974)

    • Event: WCLC 2018
    • Type: Poster Viewing in the Exhibit Hall
    • Track:
    • Presentations: 1
    • Moderators:
    • Coordinates: 9/26/2018, 12:00 - 13:30, Exhibit Hall
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      P3.08-13 - Stereotactic Body Radiotherapy (SBRT) for Oligometastatic Lung Nodules: A Single Institution Series (ID 11229)

      12:00 - 13:30  |  Author(s): Shaakir Hasan

      • Abstract
      • Slides

      Background

      Lung metastases from a primary extrapulmonary malignancy often represent widespread metastatic disease. There are circumstances, however, where disease may truly be limited. For patients that cannot undergo surgical metastatectomy, SBRT represents a non-invasive option. Herein, we report the results of using lung SBRT to treat limited lung lesions from extrapulmonary malignancies.

      a9ded1e5ce5d75814730bb4caaf49419 Method

      We retrospectively reviewed outcomes in 44 patients with 50 lung nodules treated with SBRT. Fifty percent of the patients were male and median age was 64 (38-86). The median number of nodules was 1 (1-3) and almost all patients had oligometastatic disease (90%). Thirty-four percent of patients had extrathoracic disease. Primary malignancies included bladder (2%), breast (14%), endometrial (7%), Ewings sarcoma (2%), cholangiocarcinoma (2%), colon cancer (30%), rectal cancer (20%), small bowel (2%), head and neck (14%), renal cell (5%), and thyroid (2%). Seventy-five percent of patients had systemic therapy prior to any lung SBRT.

      4c3880bb027f159e801041b1021e88e8 Result

      As above, 50 lung nodules were treated with SBRT in 44 patients. Median dose was 48 Gy (36-54 Gy) in 5 fractions (3-8). This dosing scheme yielded a median BED10 of 100 Gy (60-105.6 Gy). Follow up imaging was available for review in 96% of nodules. Median follow up from SBRT was 17.5 months (1-68). One year local control was 82%. BED10>72Gy predicted improved local control (90% vs 57% at 1 year). Local control was inversely related to SUV on pre treatment PET/CT using a cut off of 4. If lesions had SUV>4.0 local control was 67% compared to 92% at one year. One year overall survival from SBRT was 66%. There was no difference in OS if patients had extrathoracic disease. Forty-six percent of patients had distant failure at 6 months. There was no acute or late grade 3 or higher toxicity.

      8eea62084ca7e541d918e823422bd82e Conclusion

      Lung SBRT is an effective and safe tool for treatment of limited lung metastases. Dose selection remains important for local control, and lesions with increased SUV show higher predilection for local failure.

      6f8b794f3246b0c1e1780bb4d4d5dc53

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